Camp Chaos Community VBS Registration
Thank you for registering your child for Camp Chaos Community VBS at First Baptist Church Piedmont (8 1st Baptist Church Rd, Piedmont, SC 29673). Please complete one form per child. VBS will be held Sunday, July 12–Wednesday, July 15, from 6:00–8:30 PM nightly!
Child’s Full Name
*
First Name
Last Name
Child’s Age
*
Rising Grade
*
Please Select
K4
K5
1st Grade
2nd Grade
3rd Grade
4th Grade
5th Grade
Other
School Attending
*
Parent/Guardian Name
*
First Name
Last Name
Parent/Guardian Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Parent/Guardian Email Address
example@example.com
Best Way to Contact You
*
Phone
Text
Email
Emergency Contact Name
*
First Name
Last Name
Emergency Contact Relationship to Child
*
Emergency Contact Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Does your child have any allergies?
*
No
Yes
List the allergy, type of reaction, and any special instructions
*
Does your child have any medications, medical needs, inhalers, or EpiPens?
*
No
Yes
Please explain any medications or medical needs
*
Who is authorized to pick up the child?
*
Pick-up Person’s Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Are there any custody or pick-up concerns?
Does your family attend a church?
No
Yes
What church does your family attend?
May your child be photographed or recorded during VBS for church/community promotional use?
*
No
Yes
Register
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